目的:初步探讨国人中变异型心绞痛的临床特征及其性别差异.方法:回顾性分析2003-01至2009-12期间入住我院的312例自发的变异型心绞痛患者(未行激发试验)的临床资料,并对男女性别之间的临床特征进行比较,揭示性别之间的异同点.结果:变异型心绞痛好发于男性占87.8%(274/312),常见的危险因素包括吸烟、高血压、高脂血症;17.6%(55/312)的患者有过敏史;心绞痛发作时18.9%(59/312)的患者合并心律失常;造影发现有54.8%(155/283)的患者存在冠状动脉固定狭窄,7.1%(22/312)的患者合并冠状动脉肌桥.硝酸酯类、钙拮抗剂及支架置入术可以有效控制心绞痛的发作.与男性相比,女性变异型心绞痛患者中吸烟者比例低(10.5%vs 78.8%,P<0.01),冠心病家族史比例高(31.6%vs11.3%,P<0.01),室性心动过速(13.2%vs 3.6%,P<0.05)及心室颤动(7.9%vs 1.8%,P<0.05)发生的比例高.结论:变异型心绞痛为冠状动脉痉挛导致的心肌缺血,合并心律失常的比例较高,处理不及时可导致心肌梗死甚至猝死等严重情况.变异型心绞痛患者应常规接受冠状动脉造影,对于狭窄严重者应行支架置入术.与男性相比,女性变异型心绞痛患者中吸烟者比例较低,冠心病家族史比例较高,更容易出现室性心动过速及心室颤动等恶性心律失常.
Objective: To preliminarily explore the clinical characteristics and gender difference of patients with variant angina (VA) in China. Methods: A total of 312 patients with spontaneous attack of VA admitted in our hospital from 2003-01 to 2009-12 without stimulation test were retrospectively studied. The clinical features were compared between male and female patients to reveal the similarities and differences of VA by genders. Results: The predilection of VA was in male gender (274/312, 87.8%), the common risk factors including smoking, hypertension and hyperlipidemia; 55/312 (17.6%) patients had allergy history. There were 59/312 (18.9%) patients combining arrhythmia while VA attack; coronary angiography (CAG) found that 155/283 (54.8%) patients were with ifxed coronary stenosis and 22/312 (7.1%) combining coronary myocardial bridge. Nitrates, calcium antagonist and stent implantation may effectively control VA attack. Compared with male, female patients had the lower ratio of smokers (10.5% vs 78.8%),P<0.01, higher ratios of family history of coronary artery disease (CAD) (31.6% vs 11.3%),P<0.01, ventricular tachycardia (13.2% vs 3.6%)P<0.05 and ventricular ifbrillation (7.9% vs 1.8%),P<0.05. Conclusion: VA is a cardiac ischemia caused by coronary artery spasm with high incidence for combining arrhythmia, without in time treatment it may incur myocardial infarction even sudden death. VA patients should receive routine CAG and stent implantation according to the severity of stenosis. Female patients were with less smokers while higher ratios in family history of CAD, ventricular tachycardia and ventricular ifbrillation.